How monkeypox spreads: Experts clarify misinformation

Misinformation about the monkeypox outbreak is spawning a largely unfounded epidemic of anxiety, experts say.

Nearly one in five Americans worry about contracting monkeypox, according to a recent survey by the Annenberg Public Policy Center. Nearly a quarter of women surveyed said they feared contracting monkeypox, even though nearly all of the 11,177 cases in the United States were in men.

“You don’t want to send the message that this will only affect gay men,” said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, who is now president and CEO of Resolve to Save Lives. , a global public body. health initiative. Nevertheless, the virus is “primarily, overwhelmingly, a disease of men who have sex with men, transmitted through sexual contact”.

“I’m surprised at how many people I know in the United States and around the world who when I mention this are shocked like they’ve never heard this before,” he said.

The rampant spread of misinformation online is to blame for the disproportionately high anxiety, experts say.

In May, a group of South American researchers analyzed the main Twitter traffic in English regarding monkeypox. They found that half of this information was misinformation or unverifiable information; only 28% included serious and factual information.

Misleading tweets topped others in replies and retweets, according to a letter published in The Journal of Infection in Developing Countries on July 28.

Since the World Health Organization declared monkeypox a global health emergency in July, unsubstantiated claims about who is at risk and how the virus is transmitted have multiplied. Last week, WHO officials urged the public to stop attacking the monkeys after reports of primates being poisoned and killed.

In interviews with NBC News, epidemiologists and infectious disease experts dispelled some of the most common misconceptions, including whether the virus spreads easily through the air, that cases in women and children are underestimated. and that healthcare workers are at high risk.

For starters, there is no strong evidence at present that healthcare workers are at substantial risk of contracting monkeypox on the job. While 386 healthcare workers have been diagnosed with the virus globally, most contracted the virus in the community, WHO says. The agency said, however, that further investigation was needed in this matter.

Are cases in women and children missed?

A persistent misconception is that cases in women and children go undiagnosed because they are not tested.

Although there have been a small number of pediatric cases, there is no evidence of sustained transmission, according to many state and regional health agencies.

Dawn O’Connell, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, said during a call with reporters in July that monkeypox testing was being done outside of gay and bisexual men, “and we don’t see a lot of positives.”

On August 10, North Carolina health authorities reported that 30 women had been tested for monkeypox in the state. None had the virus.

Reports on the outbreak from the UK Health Security Agency also refute that significant cases in women have gone undiagnosed. In the UK, the positivity rate for men is around 50%, compared to 2% for women and less than 1% for children. A recent agency report said the large difference between test positivity rates among men and women has remained consistent During months

Throughout the 2022 outbreak, official reports from national and regional health authorities and the WHO, as well as a number of published and peer-reviewed articles, have consistently found monkeypox to be massively transmitted. through sexual contact between men.

An August 5 report from the CDC found that, through July 22, 99% of cases were in men, 94% of whom reported recent sexual contact with men. The WHO reported that 98.7% of confirmed cases worldwide were in men. Of the cases with information on sexual partners, 97.2% involve men who have sex with men.

On July 26, an international group of researchers released a report predicting that men who have sex with men would remain the only high-risk group for monkeypox infection in the current epidemic in several countries. The virus would be much more likely to reach transmission dead ends in other groups, the scientists wrote. The paper is a preprint and has not yet been peer reviewed.

Monkeypox is not caused by Covid vaccines

Claims linking monkeypox and Covid vaccines are “so crazy and false,” said Dr. Alfonso J. Rodriguez-Morales, lead author of the Twitter misinformation study and professor of infectious diseases at the University College of Medicine. the Fundación Universitaria Autónoma de las Américas in Colombia. .

Monkeypox virus was first identified in humans in 1970 and has since become endemic in 11 countries in West and Central Africa. The 2022 outbreak started as early as April in the UK

Does monkeypox spread easily on surfaces, through the air, even from food?

On Twitter, the hashtag #MonkeypoxIsAirborne gained ground. A internet rumor ruled that a person in Spain contracted the virus through contaminated handlebars on a scooter. Other thoughts online suggest that even food can transmit the virus or that toilet seats will become a major source of transmission.

A preprint article published on June 30 showed that high concentrations of the virus could be found on the surfaces of hospital rooms after they were inhabited by people with monkeypox.

And viable samples of monkeypox were found on surfaces in the household of an individual who had the virus and left the premises 15 days prior, according to a recent CDC report.

But if the virus exists in a particular place and then it will be easily infecting a person are two different things, experts point out.

“We know it’s possible for monkeypox to spread via contaminated surfaces,” said Anne Rimoin, an epidemiologist at the UCLA Fielding School of Public Health and a leading monkeypox expert. This includes, but is not limited to, bedding, sheets, towels, and unwashed clothing that has come into contact with infected lesions.

“Is this going to be a common source of transmission?” said Rimoin. “Probably not, but it’s certainly possible.”

The virus can also be transmitted through respiratory droplets during prolonged face-to-face contact.

Two recent peer-reviewed studies provide important insights into the true likelihood of these transmission routes.

The first paper, published July 21 in the New England Journal of Medicine, documented a pool of 528 global cases. The study estimated that 95% of cases were from close sexual contact between men. Only 0.8% was probably due to close non-sexual contact and 0.6% was due to household contact.

“We know the virus exists on surfaces, and we know it can be transmitted to household contacts, but those are very limited chains of transmission,” said Dr Chloe Orkin, an infectious disease expert at the Queen Mary University of London and the journal’s senior author.

The prospect of monkeypox “exploding into other communities through contact with infected surfaces,” Orkin added, “is highly unlikely, as the obvious route of transmission is sexual contact.”

In an Aug. 8 study published in The Lancet of 181 cases of monkeypox in Spain, swabs from lesions contained around 1,000 times more virus than swabs taken from the mouths and throats of infected people.

Although this finding “cannot directly answer the question of the likelihood of aerosol transmission” of monkeypox, “what we can say is that skin lesions are much more infectious than respiratory droplets”, co- Lead author Dr. Oriol Mitjà, an associate professor of infectious diseases at Germans Trias i Pujol University Hospital, Badalona, ​​Spain, said in an email.

Only 3% of the cases in the study are likely from non-sexual household contact, Mitjà said.

Is monkeypox a sexually transmitted infection?

Researchers found monkeypox in semen, but more research is needed to determine if ejaculation itself can transmit the virus. Either way, studies have suggested that anal and oral sex are the main transmission channels.

Monkeypox is likely transmitted most efficiently when lesions come into contact with mucous membranes, including in the genitals, anorectal areas or mouth and throat, Mitjà said. In comparison, healthy skin “is less efficient for transmission because the mucous membranes are less protected against infection”.

Although the general population is not currently at high risk of infection, cases could spread to other groups, “who have frequent skin-to-skin contact, such as children or adults who commonly suffer from disease outbreaks. ‘skin-to-skin infection’. Mitja said.

Rimoin offered an additional warning about the risk of monkeypox transmission. The more the virus spreads, the more it will actually transmit in “unlikely scenarios”.

“I think it’s very, very important for everyone to be careful about making bold and specific statements about how this virus will only spread,” Rimoin said.

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